Epidemiology & Biostatistics
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Item THE SYNDEMIC EFFECT OF PSYCHOSOCIAL AND STRUCTURAL FACTORS ON HIV TESTING AMONG BLACK MEN AND THE MODERATING EFFECT OF SEXUAL IDENTITY(2018) Turpin, Rodman Emory; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Black populations experience the highest incidence and prevalence of HIV in the United States. It has been posited that numerous structural and psychosocial factors contribute to HIV disparities among Black populations, these factors can have an adverse effect on healthcare utilization, including HIV testing. Given the burden of HIV rates among Black men, especially Black gay and bisexual men, it is important to consider possible barriers to HIV testing in this population. Syndemic theory posits a mutually reinforcement of social and structural conditions that cumulatively affects disease outcomes. While syndemic theory has been applied to HIV acquisition, this framework has not been utilized for HIV testing. We tested for a syndemic of depression, poverty, and a lack of healthcare access impacting HIV testing and tested sexual identity as a moderator of healthcare access in a nationally representative sample of Black men. Participants with 2 or 3 syndemic factors were significantly more likely to have never been HIV tested compared to those with 0 or 1 (49.2% to 31.7%). Having 3 syndemic factors was associated with greater prevalence of never having been HIV tested (aPR=1.46, 95% CI 1.09, 1.95). Gay/bisexual identity moderated the association between health insurance and ever having been HIV tested in adjusted models (aPR=4.36; 95% CI 1.40, 13.62), with not having health insurance being associated with HIV testing among gay/bisexual participants only (aPR=4.84, 95% CI 1.19, 19.70). Using latent class analysis, four syndemic classes were identified as significant predictors of having never been HIV tested. In adjusted log-binomial models, compared to the class with the lowest proportion of syndemic factors, the highest prevalence of never having been HIV tested was among the class with the highest proportions of syndemic component factors (aPR=2.27, 95% CI 1.83, 2.82). Overall, there is evidence of a syndemic of depression, poverty, and a lack of healthcare access that negatively affects HIV testing among Black men, with a lack of healthcare access being a significantly greater barrier to HIV testing among gay/bisexual men compared to heterosexual men.Item Racial/Ethnic Differences in Depression During the Transition to High School: Findings from the National Longitudinal Study of Adolescent to Adult Health(2015) Woodall, Ashley Marie; Chae, David H; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study investigates racial/ethnic differences in the change in depressive symptoms during the transition to high school. Weighted multivariable linear regression was used to assess the change in depressive symptoms from eighth grade to ninth grade using data from Wave I and Wave II of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Analyses revealed that non-Hispanic Black adolescents had a significantly greater increase in depressive symptoms compared to non-Hispanic White adolescents (b = 1.39, p < 0.01). Moreover, biracial/multiracial adolescents showed the greatest increase in depressive symptoms compared to non-Hispanic Whites; however this was not statistically significant (b = 2.38, p = 0.15). These findings suggest that the transition to high school is a difficult period in psychological adjustment, particularly for non-Hispanic Black and biracial/multiracial adolescents. Furthermore, these findings highlight the need for more research concerning racial identity development and the mental health of biracial/multiracial populations.Item Association of Life Events with Depressive Symptoms among Puerto Rican Youth(2014) Jaschek, Graciela; Carter-Pokras, Olivia D.; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)BACKGROUND: Early onset depressive symptoms have amplifying effects on the course of later depression, and serious personal, social and economic consequences throughout the life course. Little has been published regarding socio-demographic determinants of depression and possible mechanisms for the development of depressive symptoms among Puerto Rican youth. This study aims to examine the extent to which life events are associated with the development of depressive symptoms, and how place of residence, parental support, youth self-esteem and youth coping modify that association. METHODS: Secondary analyses were performed of data from the longitudinal Boricua Youth Study (three annual waves between 2000-2004). The sample consisted of 10-13 year old Puerto Rican youth living in New York and Puerto Rico with no depressive symptoms at wave 1, and complete information on depressive symptoms (DISC Predictive Scale which includes 9 significant predictors of depression)at waves 2 and/or 3. RESULTS: Depressive symptoms increase across waves with an increase in total, negative, or positive life events in general; and social adversity, death, and family environment life events specifically. Youth with low coping consistently had a higher number of depressive symptoms than youth with high coping regardless of number of total, negative or positive life events. Youth support from parents was found to be a significant confounder for all types of life events. Parent coping was a significant confounder for social adversity events. DISCUSSION: This study identifies various kinds of life events as risk factors that contribute to the development of depressive symptoms. Early onset depressive symptoms have amplifying effects on the course of later depression, and serious personal, social and economic consequences throughout the life course. Preventing the development of depressive symptoms at an early age should be a priority if we want to optimize the mental health and well-being of youth so that they can reach their full potential. Our findings could inform the development of a first-stage screening tool for youth at risk of developing depressive symptoms in community settings.